281 ESSEX ST - BUILDING INSPECTION (13) � - - - - - - - - - - � 3� � � �, � �{�' . .. -
Conlmon���e:Ilth of ��lassachusetts INSPECTIO dAl S�RVlC€S
Sheet ��(et.�l Permit 1015 SEP I U A � 23
` . ,� �r,nu: �— �� �S �>�nnk t�
lisiim;ucd Job C'ost: S_�S/ o ��� � -----__
I �rntit I�ce: 5
Pl:ms SubmiurJ: 1`F.S � VO____ Nlaiu Rcvicwcd: YfS ;VU �
` —` ---
� 13u,inc.s Li�ense� Applicaat Licuiueli �� C-� oZ
� Ilusin�ss (nfi�miation: �
1,� 1 roper(y pw�ur/Jub Lcx:�tion Inti�rma�ion:
� u:�„��:��S-e �v,�'Ce s u��„�:SA-1��c /1�..� 1�G L c
,,(�i s�r«<: P,f�, �3� � 33� s��<<: �Fs ! �SS.eX S i
�1 Cityll'uwn: _��GZ� Dl� � 1 1 � CirylTown:��/ l�.-✓� ��
'I'clephune: _ ��-6-7 f--��j �L{ Telephone:
Phuto I.D. reyuired/Cupy uFPhoto I.D. attached: YES_ NO__
J-1 / 1-I-ui estricted licensr s��ni��i��,i
J-2/��f-2-restrirtcd w J�vcl�ings J-.torics or Icss and commcrci�l up tu I O,UUU sy. It.!3-.torir,ur la.,
Residentful: l-2tamily_ i�tulti-lamily_ Cundu/"1'uwnhouses
_ Odnr_
C'ommcrclnl: Of'ticc_ Rztail_� Industrial
_ EJucational
(nstilutional_ Other_
tiquarc Foutagc: unJcr IO.00U sq. tt. X ovcr IOAOU sq. tt._ Namhar of Stnrtes:
Shect metal wurk to be cowpteted: �lew 1Vork:
_ Rcnovatiun:
IIVAC,_ ��le�af 1VatcrshcJ Ruutin � �
6_ Kitchui Cxliaust Syslem X
��Icwl('hinuuy i Vcnts_ ,\ir l3alancing—
Ih'u��ido Jetailyd dcx�ipliuq uf��cork to bo donr:
p✓�ev .eX y�9-vS✓ S�ST�"�
_._.
----- ---
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- - - - - - - - ' - - - - - - - - . - - - - - - - - - �-
. �
INSURANCE COVERAGE:
I h?va a current Ilabili insuranca policy or its epuivalent which m¢ab the requiremenb of M.G.L.Ch. 112 Yes�No❑
If you have chacked Yoa•Indicale the type o/coverage by checNing the approprlale box below:
A liability insuranee policy
� Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER:1 um awara that the Iiconeee does not hcae1on wal eralhia requl e9menLuired by ChaDter 112 of tho
Massachusetts General laws,and that my signatu�e on this parmit app�� —�
Cheek One Only
— Owner� Agent ❑
-------�—
$ignaWre of Ownar or Owner's Agent - �
8y chocking Nls bo�[],I hara0y eortlfy l�at all of t��datalb and lntormatlon I hav�su0m0.ted(a enbnd)repardln0 t�b applkaqon an lru�and �
�ewrab lo tM but ot my knowNtlp�and that all s���t mNal wod and InsUllatbm p�dmm�d unMr tlw P�^^n bawd far thb apPlkallon wlll b�
In compllanu w1Ui all p�itlnant prov�slon o/th�MasaaehuaNb 8ulldlnq Cod�and C�aPt�r 113 0}��C�naal Uws.
Ouet inspeetlon requlred prlor to Ineulatlon Installatlon: YES,__NO,__
Pro��ress insacction�
Connnents
D_ta
_---
�---
.--
Final lusncctinn
Comments
D:ita
�
Type ol license: I
QY ❑ntasrer ` ; �
�,.�Q ❑\laster•Restric�ea Y �
�
: �n;>ro•..n_� - C�Jaurneyuerson Slgnamre o(Licansee �
vam���� ❑Jourreyperson-Res�ncted License Numbec v U�'Z"-' i
f•J> . _.._._ _.._f._ ❑�_...._.�..�..__.,,.. �:�� II �
. Check al•:� ry n r��::�L . (
= �1J��--- '
Orepuc�or Siqn]Wro of Pcrmit Appmval ..i _._^ _'_"_..- �
I ...... _..�_._.—.��----."_---� .
� CITY OF S��I.E;tii, �'L'�SS.�CHLSETTS
• • BtiII.DL�tGDEP�R11�DiT
� l30 W�SHIIVGTOIV STREEI',3'D F1.00R
,:� � TFL (97�745-9595
' Fnx(97� 740-9846
��ygFRT FY DItISCOLt
�1AYOR "I1�toetAs ST.PI�taB
DIRECfOR OF PI:BLIC PROPERTY/HI;II.DiNG CO�L�RSS[O�iER
____ ____ ____»_.__-
Workers' Compensation Insurance A�davit: BnitderslContractors/Electricians/Plumbera
Analicant Intormation Plcase Print Leeiblv
n n
Vame(B�x��or��ze�ioNina���dua0: u/� L� �l�V/ � 1 ��U�� /���
Aaa�ss: �� o . �3r�x � � ��7
Ciry/State/Zip: P['G'/�d/�T�,�D//��Phone N:_ �T��'��.�^ 7i- ���
Are you an employer?C6eek the approprfate boz: Type oP proJeet(required):
1.�l am a employa with� 4. 0 I am a general contrecwr and 1 : 6. ❑New conxtiucti�
employees(fult aadlor paR-dme).• have hired the sut►contractors
2.� 1 am a sok proprietor or partnu- liseed on�he attached sheet� �• ❑Remodeling
, ship and�have no employer.e 'I7�cse subcontractors have 8. ❑Demolition
working for me in any capaciry. worke�s'comp.insurance. q, �Building addidon
(No wodcers'comp.inautance 5. � We am a comocadon and ita
rcquireJ.] officers have e�cercised their 10.Q Electrical repairs or addi�ions �
3.� f am a homeowner doing all work righc of exemption per MGL (1•❑Plumbing repairs w additions
myscif.[No workers'comp. c. 152,§I(4),and we have no �2,0 Roof cepaica
insurance required.J t �mployees. [h'o workera' iy�Other �U���
comp.in�urence requieed.] �'"�
. •/��Y�PliqN ihat chalce box 4i must also fip uut�he sec�im be�ow showing their wwkas'compmeyiun poliry infurmatiaa
*14imeowom who su6mit Mis aflidavU imiio�ing thry a�e doing atl xrork and then hirc oultide cm�vacrms must aubmit a�wxr�Il7davit i�icaing weh
� Cuninayun�M�cheek this 6w�muet anxhod an alditiami nheel showing�M name of tMe aubeonvacWis and their wrorkpa'mmp.poliry infama�iw.
/am an emp(oyer that Is prevfding worke�t'compensadon lnsuranes jar my emplq•ees. Below Ir the po/!cy arod fob slfe
injoemu�ion.
Insurrnce Company Name: —�
Policy/�or Self-ins.Lic.f/: Q � ��-C I {j � 7�:P���on Date: �/ � �
Job Sire Address: �PS � �"S7QX 5 / Ciry/S�ate/2ip: �/�-�-P' /��
,�ttacb a copy of the wocken'eompensatioo po8ry deetaratbn page(sAowing the pollcy aumber snd e:ptraHon d�te�
Failure to secuee coverage as required under Section 25A of MGL c. 152 can lead w the imposition of criminal penalriw of a
fine up m S 1,500.00 nnd/or one-year imprisonment,as wcll nn civit penalties in the form of a STOP WORK ORDER end a fine
of up ro 5250.00 a day against the violator. (�e advised thut a copy of this statemenl may be forwarded ro lhe Office of
Inv�stigationv uf tha DIA for insurance coverege n:rificatian.
!do hereby cen jy underlhr ' !ns nd nal�le.r ojperJary�hat tFe informadon provided above it trbe and comd
�t ir • \__--�.l.t� Dote• / Iy— / S�
Phone#:
O�cia/ust only. Do not write in thtc urea,m be curapltteAby city or fown oJj'ainL
City or Towm PermitllJcen9e#
Issuing Aulhori[y(circle onc): _
1.13narJ of Healt6 2.Building Dep•rrtment 3.Cily/Towo Clerk 4.Electdcal inspector 5. Plurobing Inspeetor
6.Ot6er
Contact Person• phane#:
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NOTES
FILL V❑ID WITH HILTI CP 606 GALV, S�TEEL RETAINING 1, W❑RK T❑ C�MPLY WITH 780 CMR CMASS, STATE
FLEXIBLE FIREST❑P SEALANT C❑LLAR 2 IN BY 2 IN BY
SPACE BETWEEN DUCT AND 18 GAGE OR BETTER C2 REQ'D) BUILDING C❑DE, 527 CMR CMASS, STATE ELECTRTCAL
❑PENING LIMITED T❑ 1/2 INCH, C❑DE), 780 CMR 66 CDUCT SYSTEMS), INTERNATI❑NAL
..
MECHANICAL C❑DE, AND ALL STATE AND1' L❑CAL
❑RDINANCES, ���� ��� �
2. EQUIPNEENT INSTALLATI❑N SHALL C❑MPLY WITH
MANIJFACTURER'S INSTRUCTI❑NS
3, �WNER SHALL MAINTAIN EQUIPNEENT AND
EXHAUST VENTILATI❑N IN GODD W❑RKING ❑RDER,
4, VENT TERMINATI❑N T❑ BE 10 FT MINIMUM ABOVE
8' GALV SPIRAL DUCT " L❑CAL GRADE.
28 Gi4GE CSEE NOTE 6) 5, MAKEUP UP AIR DAMPER T❑ BE INTERL❑CKED
0 WITH IN LINE FAN AND ❑VEN H��D SUCH THAT MAKEUP
W A � L P E N E T R A T I 0 N . AZR IS PR�VIDED WHEN ❑VEN H❑❑D AND IN LINE FAN
D E T A I L EQUIPNOENT O ARE IN ❑PERATI❑N
C � P L A C E S ) 6, J❑INTS T❑ BE SEALED WITH HIGH TEMPERATURE SILIC�NE
1 8" WALL CAP W/DAMPER AND BIRD SCREEN � AND C❑VERED WITH ALUMINMUM TAPE
2 UNIVEX H�❑D WITH MANUAL C❑NTR❑L
3 UNIVEX EC05-10 W ELECTRIC BAKERY ❑VEN Q6 780 CMR MASS STATE BUILDI�EG C�DE-8TH ED,
2801,1 MECHANICAL APPLIANCES, EQUIPMENT AND
4 ' S❑LAR & PALAU M�DEL SQB08MH1S IN LINE BELT DRIVE � SYSTEMS T❑ BE INSTALLED IN ACC�RDANCE '
CENTRIFUGAL DUCT FAN 583 CFM @ 3/4'' SP, 1/4 HP M❑T❑R WITH INTERNATIDNAL MECHANICAL C❑DE 2009,
❑R EQUIV, <SEE N❑TE 5)
5 BR❑AN M❑DEL MD10TU AUT�MATIC MAKE-UP AIR DAI�PER INTERNATI❑NAL MECHANICAL C�DE 2009
❑R EQUIV, CSEE N❑TE 5) TYPE II H❑❑D� A GENERAL KITCHEN H❑OD F❑R
6 10" WALL CAP WITH BIRD SCREEN C❑LLECTING AND REM❑VING STEAM, VAP�R,
HEAT, ❑D❑RS AND PR�DUCTS ❑F C❑MBUSTI❑N
7 S❑LAR & PALAU NC❑T❑R SAFETY GUARD MGSQB7812 T ❑ P V I E W 507,13.4 CAPACITY F❑R LIGHT-DUTY CDOKING APPLIANCES
SCALE� 1/4�� = 1�=0��) 200 CFM PER LINEAR F❑❑T ❑F H❑❑D CWALL
M❑UNTED)
, 50�,1 MAKEUP AIR SUPPLIED DURIIVG ❑PERATI❑N mF
EXHAUST SYSTEM I
506,4,1 DUCTS SERVING TYPE II H❑❑DS SHALL SHALL I
SEE DETAIL BE ❑F RIGID METALLIC MATERIALS
2% SL❑PE
506,4,2 EXHAUST ❑UTLETS SERVING TYPE II H��DS '
-� SHALL N❑T BE DIRECTI❑I� ❑NT❑ WALKWAY� AND
SEE N❑TE 4 SHALL TERMINATE N�T LESS THAN 10 FEET
� x;J FR❑M PR❑PERTY LINES, N❑T LESS THEN I
� \ �^, � � 10 FEET AB❑VE GRADE,
1Q � ,i � �,i O 12" SQ T❑ �
6 8" R N D 4 Q i
0 ----------- �
C❑NDENSATE LINE
�
VALLIER DATE� 6/19/15 ,
BAKERY '�
`-� 'I
, _
.r;°` ' ° VA � LIER BAKERY
281 ESSEX STREET �
SALEM ,
MASS
�
}' ' UNIVEX ELECTRIC ❑ VEN VENT
, ,,
- SIDE VIEW
ESSEX STREET SCALE� 1/4" = 1'=0") N❑RTHEAST C❑NSULTING ENGINEERS, INC,
BUIILDING �� L ❑ OR PLAN �4 HOLTEN STREET
SCALE; 1/16� " = 1'=0")
DANVERS, MA
i
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